198602134-7-7-2026-11-AS-PMAA-DW7LYN-20260721091036

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 07/07/2026
Date Signed: 07/07/2026 04:27:24 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/29/2026 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20260629143423

FACILITY NAME:	GLEN PARK AT LONG BEACH		FACILITY NUMBER:	198602134
ADMINISTRATOR:	ACE HUYNH		FACILITY TYPE:	740
ADDRESS:	1046 E 4TH ST		TELEPHONE:	(562) 432-7468
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90802
CAPACITY:	208	CENSUS: 114	DATE:	07/07/2026
		UNANNOUNCED	TIME BEGAN:	09:06 AM
MET WITH:	Co-Executive Director		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff are not safeguarding residents medications.

INVESTIGATION FINDINGS:

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On 07/07/26 at 9:00 am Licensing Program Analyst (LPA) Villegas conducted an initial complaint visit regarding the allegation(s) above. LPA met with Co-Executive Director Anita Csukardi as the purpose of today’s visit was explained.

The investigation consisted of the following: On 07/07/26 LPA Villegas obtained copies of the staff and resident roster, and copies of the following documents for Resident #1-3 (R1-R3) Emergency ID form, pre-appraisal,Physicians reports, needs and service plans, medication list, and Medication Administration Records (MAR) for the months of June 2026-July 2026. On 07/07/26 from 10:00am- 11:31am LPA conducted a review of medications for residents #1-7 (R1-R7). On 07/07/26 from 1pm- 1:45pm LPA conducted interviews with resident #1-10 (R1-R10), and from interviews with staff #1-4 (s1-S4).

The investigation revealed the following:
Allegation: Staff are not safeguarding residents medications.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/29/2026 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20260629143423

FACILITY NAME:	GLEN PARK AT LONG BEACH		FACILITY NUMBER:	198602134
ADMINISTRATOR:	ACE HUYNH		FACILITY TYPE:	740
ADDRESS:	1046 E 4TH ST		TELEPHONE:	(562) 432-7468
CITY:	LONG BEACH	STATE:CA	ZIP CODE:	90802
CAPACITY:	208	CENSUS: 114	DATE:	07/07/2026
		UNANNOUNCED	TIME BEGAN:	09:06 AM
MET WITH:	Executive Director Ace Huynh		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff are manipulating residents.

INVESTIGATION FINDINGS:

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On 07/07/26 at 9:00 am Licensing Program Analyst (LPA) Villegas conducted an initial complaint visit regarding the allegation(s) above. LPA met with Executive Director Ace Huynh as the purpose of today’s visit was explained.

The investigation consisted of the following: On 07/07/26 LPA Villegas obtained copies of the staff and resident roster, and copies of the following documents for Resident #1-3 (R1-R3) Emergency ID form, pre-appraisals,Physicians reports, needs and service plans, medication lists, and Medication Administration Records (MAR) for the months of June 2026-July 2026. On 07/07/26 from 10:00am- 11:31am LPA conducted a review of medications for residents #1-7 (R1-R7). On 07/07/26 from 1pm- 1:45pm LPA conducted interviews with resident #1-10 (R1-R10), and from interviews with staff #1-4

The investigation revealed the following:
Allegation: Staff are manipulating residents.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 11-AS-20260629143423

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: GLEN PARK AT LONG BEACH	FACILITY NUMBER: 198602134
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/07/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/21/2026 Section Cited CCR 87465(h)(6)(A-F)	1 2 3 4 5 6 7	(h)The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained...(A-F) records for centrally stored medications...based on records review the Department identified	1 2 3 4 5 6 7	Executive Director will retrain all medication staff on MAR documentation requirements in order to get into compliance with title 22 regulation. A weekly MAR review will be implemented to ensure all entries are completed correctly with signatures and correct dates tht match.
	8 9 10 11 12 13 14	that for July 2026 there were 16 medication documentation errors that affected 4 residents, indicating medications were not documented as required which poses a potential health and safety, and personal rights risk to persons in care.	8 9 10 11 12 13 14	LPA to receive proof by POC due that the med room staff was retrained. Training materials, staff sign in sheet, and a documented from Executive Director self certifying the review and understandment of the regulation being cited. Lizeth.villegas@dss.ca.gov
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 11-AS-20260629143423

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: GLEN PARK AT LONG BEACH	FACILITY NUMBER: 198602134
	VISIT DATE: 07/07/2026

NARRATIVE

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It is alleged that facility staff play mind games with the residents by manipulating them. On 07/07/26 LPA conducted interviews with R1-R10 regarding the allegation above. 10 of the 10 residents interviewed denied the allegation above and reported feeling respected by the facility staff. On 07/07/26 LPA conducted interviews with S1-S4 regarding the allegation above. 4 of 4 staff interviewed denied the allegation above, and reported having good interactions with residents in care.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted, and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 5

Control Number 11-AS-20260629143423

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: GLEN PARK AT LONG BEACH	FACILITY NUMBER: 198602134
	VISIT DATE: 07/07/2026

NARRATIVE

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It is alleged that residents’ medication goes missing daily with no explanation. On 07/07/26 LPA conducted interviews with R1-R10 regarding the allegation above. 7 of the 10 residents denied the allegation above and reported having no concerns with the staff who handle their medication(s). Additionally, 6 or 10 resident reported that they have never been told that their medication are unavailable. 1 of the 10 residents interviewed reported that there medications have been unavailable but reports it was due to pharmacy availability. 3 of the 10 residents interviewed reported being unaware if they take medications while currently receiving care at the facility. On 07/07/26 LPA conducted interviews with

On 07/07/26 from 10:00am- 11:31am LPA conducted a records review of the June 2026 and July 2026 medications administration records (MARs) for R1-R7. During the records review LPA observed that for July 2026 there were 16 medication documentation errors that affected 4 residents. The review showed missing initials for medications assigned to R1- Famotidine 20mg 8am- documented as refused but still in the pack for July 4th, 2026 Famotidine 20mg 4pm- documented as refused but are not in the bubble pack for July 1st-3rd 2026, Fluoxetine HCL 20mg- July 3rd, 2026 and July 7th, 2026 documented as refused but not in the bubble pack, July 6th, 2026 documented as given, then documented in the back that resident refused.
LPA observed the following for R2, Carbamazepine 8am am- July 2nd, 2026 documented given but in the bubble pack, Levetiracetam 8am July 2nd 2026 documented given but in the bubble pack, Tamsulosin 8am July 2nd, 2026 documented given but in the bubble pack. LPA observed the following for R4, Amitriptyline HCL 100mg 8 pm July 1st, 2026 documented as given but in the bubble pack, Atorvastatin 40 mg 8pm July 1st, 2026 documented as given but in the bubble pack Senna 8.6 mg 8pm July 1st, 2026 documented as given but in the bubble pack. LPA observed the following for R5 Besylate 2.5 mg 8am July 2nd, 2026 documented given but in the bubble pack, Benztropine MES 1pm 8am July 2nd, 2026 documented given but in the bubble pack, Benztropine MES 1pm 4 pm July 2nd, 2026 not signed out and not in the bubble pack, Divalproex DOS 500 mg 10pm out of bubble pack on 07/1/26, 07/3/26, 07/4/26 and on 07/5/26 but not signed out, Folic Acid 1mg 8am July 2nd, 2026 not documentation but inside bubble pack, Metformin 1000 mg 8am July 2nd, 2026 signed out but in the bubble pack, Metformin 1000 mg 4 pm July 2nd, 2026 not signed out and not in the bubble pack.

Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division (6) and Chapter (8) are being cited on the attached LIC 9099D.

Exit interview provided, appeal rights explained, and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026

LIC9099 (FAS) - (06/04)

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